- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,897.79 / $11,481.54
| Facility | | $1,202.26 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $933.25 / $2,041.74
| Professional | | $776.25 | $933.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,709.64 / $16,218.10
| Facility | | $3,388.44 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,122.02 / $2,041.74
| Professional | | $741.31 | $1,122.02 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,454.71 / $7,079.46
| Facility | | $323.59 | $2,454.71 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $2,754.23
| Professional | | $794.33 | $1,258.93 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $12,022.64
| Facility | | $1,819.70 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $1,905.46
| Professional | | $724.44 | $1,023.29 | $1,905.46 |